European Journal of Clinical Nutrition (2013) 67, 226227

& 2013 Macmillan Publishers Limited All rights reserved 0954-3007/13

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SHORT COMMUNICATION
b-glucans reduce LDL cholesterol in patients with
myasthenia gravis
L Haggard, M Andersson and AR Punga

We aimed at evaluating whether b-glucans could improve low-density lipoprotein (LDL) cholesterol levels and/or glycemic control
in patients with myasthenia gravis (MG), in whom statins usually have muscle-related side effects. Fifty-nine MG patients
participated in the study and received a daily dietary supplement of 3 g of b-glucans during 8 weeks. Body mass index (BMI) and
blood sample analysis of lipid and glucose status were performed before and after 8 weeks intake of b-glucans. In the 52 patients
who completed the study, there was a signicant reduction in total cholesterol, LDL, ApoA1 and ApoB (all Po0.003). However,
glycemic control and BMI were unaltered. The present study indicates that 8 weeks daily intake of 3 g of b-glucans signicantly
reduces total cholesterol, LDL, ApoA1 and ApoB in MG patients. b-glucans may therefore be of value in improving lipid status in MG
patients, without the muscle-related side effects accompanied by statins.

European Journal of Clinical Nutrition (2013) 67, 226227; doi:10.1038/ejcn.2012.191; published online 28 November 2012
Keywords: b-glucans; LDL cholesterol; myasthenia gravis; glycemic control

INTRODUCTION
Low-density lipoprotein cholesterol (LDL-C) is of major importance
for development of cardiovascular events through atherosclerosis1
and thus, lowering LDL-C signicantly reduces the risk for
cardiovascular events through statins.2 Myasthenia gravis (MG)
is an autoimmune neuromuscular disorder that causes skeletal
muscle fatigue, and in MG patients, statins may cause aggravated
muscle fatigue.3
b-glucans are natural ingredients in oat and 3 g daily is
proclaimed to reduce LDL-C levels by 56%.4 In addition,
b-glucans improve long-term glycemic control in diabetes
patients.5 Chronic corticosteroid treatment in many MG patients
increases blood glucose levels and the risk of developing type II
diabetes. Further, MG patients are limited regarding physical
activity and hence a dietary supplement that reduces cholesterol
without side effects would be a welcome to avoid development of
cardiovascular disease.
MATERIALS AND METHODS
Study design
This was a prospective, non-placebo-controlled study, where each patient
was his/her own control. The primary hypothesis was that b-glucans
reduce LDL-C in MG patients and the secondary hypothesis was that
b-glucans improve glycemic control. All subjects gave their written
informed consent to participate in the study, which was approved by
the Regional Ethical Review Board of Uppsala (Dnr: 2011/35).
Subjects. Fifty-nine MG patients (28 women and 31 men) aged 3090
years were recruited from Uppsala University Hospital and surrounding
hospitals. Exclusion criteria were pre-existing supplement with b-glucans
or gluten intolerance.
Experimental design and reference values. At the initial visit, body mass
index (BMI) was assessed. BMI 1925 normal, 2630 overweight,
3135 obesity, 3640 severe obesity and 440 extreme obesity.
A venous blood sample was analysed for total cholesterol (o5.0 mmol/l),
high-density lipoprotein (HDL)-C (40.9 mmol/l), LDL-C (o3.0 mmol/l), LDL/
HDL ratio (o5.0 mmol/l), triglycerides (o1.8 mmol/l), ApoA1 (41.2 g/l),
ApoB (o1.2 g/l), ratio of ApoA1/ApoB (o0.9), HbA1c (IFCC; 3146 mmol/
mol), HbA1c % (4.05.4%) and fasting blood glucose (4.06.0 mmol/l).
Dietary supplementation consisted of 3 g b-glucans (Betaglucare;
Prorsum Healthcare AB, Gothenburg, Sweden) daily for 8 weeks. Patients
were informed to keep their diet and medication consistent, and asked
regarding compliance with Betaglucare via phone after 12 weeks. Blood
sample analysis and BMI were assessed again after 8 weeks.
Drop out patients. Seven patients did not complete the entire study
owing to gastrointestinal side effects (N 2), radial fracture (N 1),
difculties chewing Betaglucare (N 1), change in address (N 1) and
unknown reason (N 2).
Statistical analysis. Two-sided one-sample t-tests were performed based
on within-patient change over time. The hypothesis for each test was
that the mean value of the difference from baseline (day 0) to the follow-
up at 8 weeks equals 0 (no difference). The signicance level was Po0.05.
RESULTS
Medical history and baseline status
MG disease duration was 048 years (mean 10 years) among
the 59 included patients. In total, 81% had elevated BMI, out of
which 50% had BMI42530, 19% had BMI43035 and 12% had
BMI435. Median baseline BMI was 28.5. Eighteen (31%) patients
had hypertension and ten (17%) patients had a diagnosed
hypercholesterolemia, out of which nine (90%) patients had statin
treatment. Diabetes was noted in nine (15%) patients and insulin
injections were required in seven cases.
Approximately 81% of the patients had elevated total
cholesterolX5 mmol/l and 70% of patients had LDLX3 mmol/l
(Table 1). Furthermore, 44% had elevated TGsX1.8 mmol/l and

Department of Clinical Neurophysiology, Institute of Neuroscience, Uppsala University, Uppsala, Sweden. Correspondence: Dr AR Punga, Department of Clinical Neurophysiology,
Institute of Neuroscience, Uppsala University, UAS, entrance 85, 3rd oor, 75185 Uppsala, Sweden.
E-mail: annarostedtpunga@gmail.com
Received 24 September 2012; revised 29 October 2012; accepted 30 October 2012; published online 28 November 2012
 b-glucans reduce LDL cholesterol in MG
L Haggrd et al
227
meta-analysis, where decreased ApoB improved coronary heart
Table 1. Blood sample analysis of lipid and glucose status at baseline
disease prediction when added to LDL-C reduction.9 Interestingly,
N Mean S.d. Mean S.d. P-value though, the statin trials were done over several years compared
change change with 8 weeks with b-glucans.
Although a previous study showed that 4 g of b-glucans reduce
Cholesterol 57 (48) 5.9 1.0  0.4 0.7 0.0005** postprandial blood glucose levels in healthy subjects,10 3 g of
HDL 57 (49) 1.6 0.6  0.1 0.4 0.17 b-glucans did not signicantly reduce HbA1c or fasting blood
LDL 57 (49) 3.5 0.9  0.3 0.5 0.0002** glucose. Our low number of diabetic patients could have made it
(LDL/HDL) 57 (49) 2.5 1.0  0.1 0.4 0.13 difcult to prove a reduction of normal HbA1c levels and
Glucose 58 (49) 6.3 1.8  0.2 1.2 0.31
additionally we did not determine postprandial blood glucose
HbA1c 58 (51) 42.9 9.8  0.2 3.9 0.77
HbA1c (%) 58 (50) 5.1 0.9  0.0 0.4 0.81 levels.
Triglycerides 57 (49) 1.71 0.78  0.03 0.61 0.75 In conclusion, 3 g of b-glucans signicantly reduce total
ApoA1 55 (44) 1.72 0.39  0.08 0.17 0.0028* cholesterol, LDL-C and ApoB after 8 weeks of supplementation
ApoB 55 (44) 1.00 0.22  0.07 0.11 0.0003** in MG patients. b-glucans may therefore serve as a dietary
(ApoB/ 54 (44) 0.61 0.18  0.01 0.07 0.25 supplement in reducing LDL-C in these patients, without the
ApoA1) muscle-related side effects that often accompany statins.
Abbreviations: ApoA1, protein component of HLD; ApoB, protein
component of LDL; HbA1c, glycated glucose; HDL, high-density lipopro-
tein; LDL, low-density lipoprotein. The unit for cholesterol, HDL, LDL and CONFLICT OF INTEREST
triglycerides is mmol/l, and for HbA1c mmol/mol. ApoA1 and ApoB were
The authors declare no conict of interest.
measured in g/l. N indicates number of patients at baseline and (at
8 weeks). Mean change indicates absolute mean change at week 8,
compared with baseline. *Pp0.01, **Pp0.001.
ACKNOWLEDGEMENTS
The authors thank Lille-Mor Jansson, nurse at the Neurology Clinic, Uppsala
27% had an ApoBX1.2 g/l. Regarding glycemic status, 20% of University Hospital.
patients had an elevated HbA1c (IFCC) value446 mmol/mol and
40% had morning blood glucose46 mmol/l. Ten percentage of
patients were non-fasting, which may have contributed to slightly
REFERENCES
false high levels.
1 National Cholesterol Education Program (NCEP) Expert Panel on Detection, Eva-
luation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment
Improved LDL-C but unchanged glycemic control after b-glucan Panel III). Third Report of the National Cholesterol Education Program (NCEP)
treatment Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
Fifty-two patients completed the study. Total cholesterol was in Adults (Adult Treatment Panel III) nal report. Circulation 2002; 106: 31433421.
reduced by 0.4 mmol/l, on average a 5.5% reduction (P 0.0004). 2 Delahoy PJ, Magliano DJ, Webb K, Grobler M, Liew D. The relationship between
LDL-C was reduced by 0.3 mmol/l (7.5%; P 0.0002); with a slightly reduction in low-density lipoprotein cholesterol by statins and reduction in risk of
cardiovascular outcomes: an updated meta-analysis. Clin Ther 2009; 31: 236244.
higher reduction in patients with baseline LDL-CX3 mmol/l. LDL-C
3 Oh SJ, Dhall R, Young A, Morgan MB, Lu L, Claussen GC. Statins may aggravate
was reduced in 35 patients and slightly increased in 14 patients at myasthenia gravis. Muscle Nerve 2008; 38: 11011107.
follow-up. LDL-C was equally reduced by 0.3 mmol/l in patients 4 Wolever TM, Tosh SM, Gibbs AL, Brand-Miller J, Duncan AM, Hart V et al. Physi-
with and without diabetes, as well as in patients with normal or cochemical properties of oat beta-glucan inuence its ability to reduce serum LDL
elevated BMI. Further, ApoA1 was reduced by 0.08 g/l, (4.7%; cholesterol in humans: a randomized clinical trial. Am J Clin Nutr 2010; 92:
P 0.0028) and ApoB was reduced by 0.07 g/l (6.1%; P 0.0008). 723732.
There was no signicant reduction of TGs (P 0.75), HDL-C 5 Pick ME, Hawrysh ZJ, Gee MI, Toth E, Garg ML, Hardin RT. Oat bran concentrate
(P 0.18) or ApoB/ApoA1 ratio (P 0.25). Body weight, and bread products improve long-term control of diabetes: a pilot study. J Am Diet
consequently BMI, was unchanged (P 0.20). Mean HbA1c Assoc 1996; 96: 12541261.
6 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
changed from 42.943.1 mmol/mol, indicating unaltered glycemic
in Adults. Executive Summary of The Third Report of The National Cholesterol
control (P 0.77). Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment
of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:
24862497.
DISCUSSION 7 Braaten JT, Wood PJ, Scott FW, Wolynetz MS, Lowe MK, Bradley-White P et al. Oat
Lowering LDL-C reduces the risk of coronary heart disease,6 and beta-glucan reduces blood cholesterol concentration in hypercholesterolemic
b-glucans have been shown to reduce LDL-C.7,4 MG patients subjects. Eur J Clin Nutr 1994; 48: 465474.
cannot perform physical exercise as healthy subjects, which could 8 Purvin V, Kawasaki A, Smith KH, Kesler A. Statin-associated myasthenia gravis:
contribute to the observed obesity and high LDL-C levels. report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85: 8285.
9 Robinson JG, Wang S, Jacobson TA. Meta-Analysis of comparison of effectiveness
Musculoskeletal statin-associated side effects are the most
of lowering apolipoprotein B versus low-density lipoprotein cholesterol and
prevalent and statins may also aggravate MG fatigue.3,8 Our nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in ran-
study conrmed that 3 g of daily b-glucan supplementation domized trials. Am J Cardiol 2012; 110: 14681476.
signicantly reduced total cholesterol by 5.5%, LDL-C by 7.5% and 10 Granfeldt Y, Nyberg L, Bjorck I. Muesli with 4 g oat beta-glucans lowers glucose
ApoB by 6.1% in only 8 weeks. The importance of this com- and insulin responses after a bread meal in healthy subjects. Eur J Clin Nutr 2008;
bined reduction of LDL-C and ApoB was highlighted in a recent 62: 600607.

& 2013 Macmillan Publishers Limited European Journal of Clinical Nutrition (2013) 226 227
 b-glucans reduce LDL cholesterol in MG
L Haggrd et al
227
meta-analysis, where decreased ApoB improved coronary heart
Table 1. Blood sample analysis of lipid and glucose status at baseline
disease prediction when added to LDL-C reduction.9 Interestingly,
N Mean S.d. Mean S.d. P-value though, the statin trials were done over several years compared
change change with 8 weeks with b-glucans.
Although a previous study showed that 4 g of b-glucans reduce
Cholesterol 57 (48) 5.9 1.0  0.4 0.7 0.0005** postprandial blood glucose levels in healthy subjects,10 3 g of
HDL 57 (49) 1.6 0.6  0.1 0.4 0.17 b-glucans did not signicantly reduce HbA1c or fasting blood
LDL 57 (49) 3.5 0.9  0.3 0.5 0.0002** glucose. Our low number of diabetic patients could have made it
(LDL/HDL) 57 (49) 2.5 1.0  0.1 0.4 0.13 difcult to prove a reduction of normal HbA1c levels and
Glucose 58 (49) 6.3 1.8  0.2 1.2 0.31
additionally we did not determine postprandial blood glucose
HbA1c 58 (51) 42.9 9.8  0.2 3.9 0.77
HbA1c (%) 58 (50) 5.1 0.9  0.0 0.4 0.81 levels.
Triglycerides 57 (49) 1.71 0.78  0.03 0.61 0.75 In conclusion, 3 g of b-glucans signicantly reduce total
ApoA1 55 (44) 1.72 0.39  0.08 0.17 0.0028* cholesterol, LDL-C and ApoB after 8 weeks of supplementation
ApoB 55 (44) 1.00 0.22  0.07 0.11 0.0003** in MG patients. b-glucans may therefore serve as a dietary
(ApoB/ 54 (44) 0.61 0.18  0.01 0.07 0.25 supplement in reducing LDL-C in these patients, without the
ApoA1) muscle-related side effects that often accompany statins.
Abbreviations: ApoA1, protein component of HLD; ApoB, protein
component of LDL; HbA1c, glycated glucose; HDL, high-density lipopro-
tein; LDL, low-density lipoprotein. The unit for cholesterol, HDL, LDL and CONFLICT OF INTEREST
triglycerides is mmol/l, and for HbA1c mmol/mol. ApoA1 and ApoB were
The authors declare no conict of interest.
measured in g/l. N indicates number of patients at baseline and (at
8 weeks). Mean change indicates absolute mean change at week 8,
compared with baseline. *Pp0.01, **Pp0.001.
ACKNOWLEDGEMENTS
The authors thank Lille-Mor Jansson, nurse at the Neurology Clinic, Uppsala
27% had an ApoBX1.2 g/l. Regarding glycemic status, 20% of University Hospital.
patients had an elevated HbA1c (IFCC) value446 mmol/mol and
40% had morning blood glucose46 mmol/l. Ten percentage of
patients were non-fasting, which may have contributed to slightly
REFERENCES
false high levels.
1 National Cholesterol Education Program (NCEP) Expert Panel on Detection, Eva-
luation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment
Improved LDL-C but unchanged glycemic control after b-glucan Panel III). Third Report of the National Cholesterol Education Program (NCEP)
treatment Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
Fifty-two patients completed the study. Total cholesterol was in Adults (Adult Treatment Panel III) nal report. Circulation 2002; 106: 31433421.
reduced by 0.4 mmol/l, on average a 5.5% reduction (P 0.0004). 2 Delahoy PJ, Magliano DJ, Webb K, Grobler M, Liew D. The relationship between
LDL-C was reduced by 0.3 mmol/l (7.5%; P 0.0002); with a slightly reduction in low-density lipoprotein cholesterol by statins and reduction in risk of
cardiovascular outcomes: an updated meta-analysis. Clin Ther 2009; 31: 236244.
higher reduction in patients with baseline LDL-CX3 mmol/l. LDL-C
3 Oh SJ, Dhall R, Young A, Morgan MB, Lu L, Claussen GC. Statins may aggravate
was reduced in 35 patients and slightly increased in 14 patients at myasthenia gravis. Muscle Nerve 2008; 38: 11011107.
follow-up. LDL-C was equally reduced by 0.3 mmol/l in patients 4 Wolever TM, Tosh SM, Gibbs AL, Brand-Miller J, Duncan AM, Hart V et al. Physi-
with and without diabetes, as well as in patients with normal or cochemical properties of oat beta-glucan inuence its ability to reduce serum LDL
elevated BMI. Further, ApoA1 was reduced by 0.08 g/l, (4.7%; cholesterol in humans: a randomized clinical trial. Am J Clin Nutr 2010; 92:
P 0.0028) and ApoB was reduced by 0.07 g/l (6.1%; P 0.0008). 723732.
There was no signicant reduction of TGs (P 0.75), HDL-C 5 Pick ME, Hawrysh ZJ, Gee MI, Toth E, Garg ML, Hardin RT. Oat bran concentrate
(P 0.18) or ApoB/ApoA1 ratio (P 0.25). Body weight, and bread products improve long-term control of diabetes: a pilot study. J Am Diet
consequently BMI, was unchanged (P 0.20). Mean HbA1c Assoc 1996; 96: 12541261.
6 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
changed from 42.943.1 mmol/mol, indicating unaltered glycemic
in Adults. Executive Summary of The Third Report of The National Cholesterol
control (P 0.77). Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment
of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:
24862497.
DISCUSSION 7 Braaten JT, Wood PJ, Scott FW, Wolynetz MS, Lowe MK, Bradley-White P et al. Oat
Lowering LDL-C reduces the risk of coronary heart disease,6 and beta-glucan reduces blood cholesterol concentration in hypercholesterolemic
b-glucans have been shown to reduce LDL-C.7,4 MG patients subjects. Eur J Clin Nutr 1994; 48: 465474.
cannot perform physical exercise as healthy subjects, which could 8 Purvin V, Kawasaki A, Smith KH, Kesler A. Statin-associated myasthenia gravis:
contribute to the observed obesity and high LDL-C levels. report of 4 cases and review of the literature. Medicine (Baltimore) 2006; 85: 8285.
9 Robinson JG, Wang S, Jacobson TA. Meta-Analysis of comparison of effectiveness
Musculoskeletal statin-associated side effects are the most
of lowering apolipoprotein B versus low-density lipoprotein cholesterol and
prevalent and statins may also aggravate MG fatigue.3,8 Our nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in ran-
study conrmed that 3 g of daily b-glucan supplementation domized trials. Am J Cardiol 2012; 110: 14681476.
signicantly reduced total cholesterol by 5.5%, LDL-C by 7.5% and 10 Granfeldt Y, Nyberg L, Bjorck I. Muesli with 4 g oat beta-glucans lowers glucose
ApoB by 6.1% in only 8 weeks. The importance of this com- and insulin responses after a bread meal in healthy subjects. Eur J Clin Nutr 2008;
bined reduction of LDL-C and ApoB was highlighted in a recent 62: 600607.

& 2013 Macmillan Publishers Limited European Journal of Clinical Nutrition (2013) 226 227